10-1329 (PLBG)P.O. BOX 1504
78495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
(F-4'�v4'4QW4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 10-00001329
Property Address: 79360 DESERT ROCK CT
APN: 604-242-007-17 -23935
Application description: PLUMBING
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 346
Applicant: _ ,P Architect or Engineer:
P JA
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Seciion 7000) of Division 3 of the Business and cofessionals Code, and my License is in full force and effect.
Lic nse CIa sn: B -C10 -C36 License No.: 811114
Date:1 �5�ractor. )MOT
OWNER -BUILDER DECLARATION
. I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
(_) 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
1 _ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
(_ 1 1 am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
DANIELS ROBERT C
79-360 DESERT ROCK COURT
LA QUINTA, CA 92253 D
Contractor:
CALIFORNIA DELTA MECHNICALIINC
6052.E. BASELINE RD, #155 f
MESA, AZ 85206
('866)692-5273
Lic. No.: 811114
Date: 12/07/10
n
=tet
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c IF r rQ`iC'.� i.?:ASM j'
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier STATE FUND Policy Number 1697823
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so as to become subject to the workers' compensation laws of California,
and agree that, if I should become subject to the workers' compensation provisions of Section
3700 of the Labor Code, 4N I forthwith comply with those provisions.
r
aD te:pplicant:
WARNIN : FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application'is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quihta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building onstrucYon, and hereby authorize representatives
ofthis cou ty t enter upon the above-mentioned property, r i specti pur
Date: �� gnature (Applicant or Agent):
1,
Application Number . . . . . 10-00001329
Permit . .
. PLUMBING
Additional desc .
Permit Fee . . .
. 22.50 Plan Check
Fee
5.63
Issue Date
Valuation
. . .
. 0
-Expiration Date
6/05/11
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 7.5000 EA PLB WATER HEATER/VENT
7.50
-------------------------------------------------
Special Notes and
---------------------------
Comments
REPLACE 50 GALLON
GAS WATER HEATER. 2007
CODES.
L
-----------------------------------------------------
Other Fees . .
----------------------
. . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary
Charged Paid Credited
Due
---
Permit Fee Total
---------- ---------- ----------
22.50 .00
----------
.00
22.50
Plan Check Total
5.63 .00
.00
5.63
Other Fee.Total
1.00 .00
.00
1.00
Grand Total
29.13 .00
.00
29.13
LQPERMIT
Dec. T. 2010 10:31AM DELTA MEC.HAN.ICA"L No. 4015. P. 3.
Piescriptive Certificate of Compliance: Residential Nater Heating CF -IR -
General Information
Site Address: 79,74 0 f G Climate Zone: ,�' Date: /-L/,7/10
NOTB. MY form is'onl used fot alteration or.addidon of water heatin stens
Cont motor (Documentation Author's /Responsible De -signer's Declaration Statement)
• . I eeidfy that this Ceirificate of Compliance documentation is aocatatc and complete. '
• I On eligible underVyWoti 3 of the California Business and Professiona.Code to accept responsibility for the building design identified on
this Ccrtificate of Compliance:
• I certify that the energy features and petformsnee spcoilieations for the building design ident�ed on this Certificate of Compliance conform
to the requirements of Title 24, Parts I and 6 of the Cal orcin Codo of Regulations.
'The building design features identified oa this Certificate of Compliance are consistent with the information provided to document this
budding design on the other applicable Compliance forms, worksheets; decalations, plans and specifications submitted to the enforcement
agmuy for approval with this hWi permit application.
Name
Compsay'CalVomla Delta Mechanical Date:
4":6056-E. Basellne. Rd., #155 License:811 11�
City/St8te4:Mesa; AZ 85208 1Pbcn0:8687692-5273
2008 Resi*ntidl Compliance Forms
Dec. 7. 2010 10:36AM DELTA MECHANICAL
No. 4015 P. 2
Bln
City 0f La Quints
Sullding a Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Qulnta, CA 92253 - (760),777-7012
Ulding Permit Application and Tracking Sheen
Permit #
\D'
ProjeotAddtess: 7413Z 0
Owner's Name:
A. P. Number.
Addrw, e, ®' ,
Legal Description:
Contractor.
p
City. ST, Zip- LA 0,71 l �Z-
YrojectDcscription:
City' ST, ZiP. &6) g5w b
t .
Telephone:
Stats Lie. # : j LieA to foo y
Arch., Engr., Designer,
Address:
City., ST, Zip:
Telephone:
Construction Typc: Occupancy:
Project typo (circle one): New. Add'n Dane
Sq. Ft: # Stories: # Unita:
State Lia #
a
Name of Contact Person' /1�/
Telephone # of contact Pelson
Estimated Value of Pmjccr ,
APPLICANT. DO NOT WRrrF BELOW THIS LINE
#
Snbwittal
'd
RM14
TRAC75UVG
Plan Seta
Structural Calm
Plan Cheek submitted
Reviewed, ready for corrections
Item
Plan CbeckDeposit
A aom►t
Truss Calc16
Called Contact Perron
Plan ChZek >321anee.
Title 24 Cala.
Plans pickid up
Coastrncfion
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
V Revlew, ready for correctlowlissue
Electrical
80contaetor Lfrt
Called Contact Person
Plumbing
GrantDeed
Plana picked up
$.M,L
1LO.A. Approval
Plans resubmitted
Gradlag
IN HOUSE:-
"'d R vlew, ready for correctionvInue
Developer Impact Fee
Planning Approval
Called ContaetParsou
I A,LPP.
Pub. Wko. Appr
Date of permit ieaue
Schodl Fees
Total Permit Feea